胸腺肽捕助治疗对糖尿病合并肺结核患者治疗效果及血清中免疫细跑水平的影向【摘要】目的探讨胸腺肽注射液辅助治疗糖尿病合并肺结核患者的临床效果及患者血清中免疫细胞水平的影响。方法选取本院2014年6月至2016年6月在院治疗，经T-sot.TB诊断为结核潜在感染的糖尿病患者98例，根据患者自愿原则分为采用常规治疗的对照组和联合胸腺肽辅助治疗的对照组，对比两组患者结核治疗效果、血清中免疫细胞水平。结果：观察组患者强化期结束、疗程结束涂阳转阴分别为37、42例，培养转阴分别为36例、41例，与对照组患者数据比较无差异，P>0.05:对比不同类型患者血清中免疫细胞水平，结果发现正常人群血清中Treg细胞水平为1.3±0.6，明显低于糖尿病和糖尿病合并肺结核患者，而T17细胞水平为3.5±1.2，明显高于糖尿病患者和糖尿病合并肺结核患者，差异显著，具有统计学意义：两组患者治疗前Treg细胞核Th17细胞水平对比无差异，具有可比性，随着治疗的进展Treg细胞含量依次下降，但观察组患者强化期结束和疗程结束Treg含量分别为2.2±0.8、1.7±0.5，相比含量低于对照组，T17细胞含量逐渐上升，但是观察组患者强化期结束和疗程结束Th17细胞含量分别为2.5±0.6,3.1±0.7，明显高于对照组患者，差异显著，具有统计学意义：两组患者治疗后症状发生情况对比无差异，治疗后观察组患者乏力、盗汗、食欲下降、咳嗽、咳痰消失率分别为88.89%、87.10%、86.36%、75.0%、88.89%，明显高于对照组，差异显著，具有统计学意义。结论：在强化抗痨治疗的同时采用胸腺肽注射辅助提高患者免疫功能，有助于改善患者T细胞亚群，促进患者临床症状的缓解，值得临床推广运用。【关键词】胸腺肽：糖尿病合并肺结核：效果：免疫Effect of immune cells and serum level of clinical effect in patients withThymopeptide Enteric Injection adjuvant treatment of diabetes complicated withpulmonary tuberculosis[Abstract]Objective To investigate the effect of immune cells and serum level ofclinical effect in patients with Thymopeptide Enteric Injection adjuvant treatmentof diabetes complicated with pulmonary tuberculosis..Methods 98 cases of diabeticpatients with tuberculosis infection in our hospital from June 2014 to June 2016,diagnosed by T-spot.TB in,according to the principle of voluntary patients weredivided into the control group and the control group with conventional therapycombined with thymosin adjuvant therapy,immune cell level contrast effect,thetreatment group of two patients with tuberculosis in serum.Result:Patients in theobservation group at the end of the end of the treatment,strengthening the smearnegative were 37,42 cases were culture negative were 36 cases,41 cases had nodifference compared with the control group,the patient data P>0.05:serum levelsof immune cells in patients with different types of contrast,found that the normalserum level of Treg cells was 1.3+.6.Was significantly lower than that in patientswith diabetes and diabetes combined with pulmonary tuberculosis,and the level ofTh17 cells was 3.5+1.2,significantly higher than in patients with diabetes anddiabetes combined with pulmonary tuberculosis was significantly different,withstatistical significance:the two groups were compared before Treg cell nuclear Th17cells had no significant difference,comparable with the progress in the treatmentof Treg cells in order to decrease,but the patients in the observation group enhancedTreg content and the end of treatment were2.2±0.8，l.7±0.5，compared were lowerthan control group,Th17 cell content Increased gradually,but the patients in theobservation group were enhanced Th17 cells content end and course of treatment were2.5+0.6,3.1+0.7,significantly higher than in the control group,the differencewas statistically significant:two groups of patients after treatment of symptomscompared to no difference,the observation group after treatment in patients withfatigue,sweating,loss of appetite,cough and sputum disappear rate were 88.89%,87.10%,86.36%,75%,88.89%,significantly higher than the control group,thedifference was statistically significant.Conclusion:At the same time:strengthening anti tuberculosis treatment with thymosin injection auxiliaryenhancing immune function,help to improve the T cell subsets of patients,promotethe clinical symptom remission,is worthy of clinical application[Key words]Thymosin:diabetes mellitus complicated with pulmonary tuberculosis:immune effect糖尿病是目前发病率最高的慢性代谢性疾病，糖尿病以葡萄糖和脂肪代谢素乱、血浆葡萄糖水平持续增高为主要特点[1,2]。临床表现为多饮、多食、多尿，持续血糖升高可导致心脑血管、肾、眼及神经等病变。糖尿病患者免疫功能下降，容易并发肺结核，糖尿病患者合并肺结核[3]。患者持续存在高血糖局部细菌生长旺盛而且患者免疫力下降容易导致肺结核扩散，导致肺结核治愈率较前明显下降[4]。胸腺肽注射液有助于提高患者免疫力，在糖尿病肺结核患者中运用有可能提高患者免疫力，改善患者治疗效果[5]。本研究性分析我院98例糖尿病合并肺结核患者的临床资料，探讨胸腺肽注射液对糖尿病合并肺结核患者治疗效果及免疫细胞水平的影响，现将研究结果报道如下：1资料和方法1.1一般资料选取本院2014年6月至2016年6月在院治疗，经T-spot.TB诊断为结核潜在感染的糖尿病患者98例，结核潜在感染诊断标准参照《活动性和潜伏性结核病的诊断：NICE指南概要》，其中糖尿病均为2型糖尿病，2型糖尿病的诊断符合中华医学会内分泌与代谢疾病分会制定的相关诊断标准，入选标准：①同意进行本研究，并能完成随访：②确诊为2型糖尿病合并肺结核：排除标准：①合并其他脏器疾病的患者包括肝肾功能不全：②合并有恶性肿瘤、精神疾病等：③病例资料不完整，不能完成随访的患者：⑤合并其他部位感染的患者。98例患者根据患者自愿使用胸腺肽，分为常规治疗的对照组和采用胸腺肽辅助治疗的观察组患者，其中观察组患者49例，男性25例、女性24例，BT指数(22.5±1.6)kg/m、年龄(53.6±3.6)岁，对照组49例患者，男性24例，女性25例，BI指数(22.8±1.2)kg/m,年龄(53.2±3.4)岁，两组患者性别、年龄、体重指数对比无差异，具有可比性，并同时选取同期我院正常人群、2型糖尿病患者各30例作为同期对照组，性别、年龄、体重指数与患者匹配，所有患者均知情同意本研究，本研究经我院伦理委员会批准。1.2方法所有患者均采用肺结核的标准治疗，（标准四联抗结核）()观察组患者在肺结核治疗的基础上联合胸腺肽注射液，具体用法如下：静脉滴注：胸腺肽注射液50mg+5%葡萄糖注射液静脉滴注，1次/日。1.3观察指标①血清中免疫细胞水平检测：血清中CD4+CD25+Treg细胞和Th17细胞含量：收集患者空腹外周静脉血，用active motif公司的试剂盒按说明书提取外周血单核细胞(PBMCs),得到PBMCs后PBS重悬细胞，取2Oul细胞悬液，调节细胞浓度，按照流式细胞检测说明书加入相流式细胞仪抗体后，按照说明书进行相关操作，流式细胞仪上检测细胞Treg细胞和Th17细胞含量，Treg细胞采用Foxp3 Alexa F1uor488/CD25PE/CD4 PerCP,Th17细胞采用抗人IL-17A1exaF1uor647/CD3FITC/CD4PE,两种抗体均购于上海百赛生物科技有限公司：②治疗前及治疗后3、8个月复查抗酸杆菌、结核分枝柑橘培养、胸部X线：③详细观察并记录治疗前、后乏力、盗汗、食欲下降、咳嗽、咳痰消失率1.4统计学处理采用SPSS22.0软件进行数据统计分析，计量资料采用x±s表示，组间比较采用独立样本t检验：计数资料采用%表示，采用卡方检验：以P<0.05表示差异具